NR 547 PMHNP Midterm Study Guide | Practice Questions, Answers &
Rationales | 2027 Edition
Prepare for the NR 547 PMHNP Midterm with this comprehensive study guide featuring original practice
questions, accurate answers, and detailed rationales. Covers psychiatric assessment, differential
diagnosis, DSM-5-TR disorders, psychopharmacology, neurobiology, evidence-based treatment, and
clinical decision-making essential for psychiatric-mental health nurse practitioner students. Perfect for
focused review, self-assessment, and building confidence before your NR 547 midterm exam.
QUESTION 1
A 45-year-old female presents with a 3-week history of depressed mood, anhedonia,
insomnia, and poor appetite. She reports that her symptoms began shortly after she was
diagnosed with breast cancer. She is able to perform her daily activities but with
significant effort. What is the most appropriate diagnosis?
A) Major depressive disorder
B) Adjustment disorder with depressed mood
C) Persistent depressive disorder
D) Uncomplicated bereavement
Correct Answer: B) Adjustment disorder with depressed mood
Rationale: Adjustment disorder is characterized by emotional or behavioral symptoms
within 3 months of an identifiable stressor (cancer diagnosis). The symptoms do not meet
full criteria for MDD. Persistent depressive disorder requires ≥2 years of symptoms.
Uncomplicated bereavement is related to loss of a loved one.
QUESTION 2
A 32-year-old male reports recurrent episodes of intense fear, palpitations, sweating,
and a feeling of choking that peak within 10 minutes. He has persistent worry about
having additional attacks and has changed his behavior to avoid situations that might
trigger them. What is the most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Social anxiety disorder
D) Specific phobia
,Correct Answer: B) Panic disorder
Rationale: Panic disorder is characterized by recurrent unexpected panic attacks followed
by at least 1 month of persistent concern about additional attacks or significant
maladaptive behavioral changes. GAD involves pervasive worry without discrete panic
attacks. Social anxiety is limited to social situations. Specific phobia is triggered by a
specific object or situation.
QUESTION 3
A 28-year-old female presents with a 2-year history of persistent depressed mood, low
energy, poor appetite, low self-esteem, and hopelessness. She reports that she has
never been symptom-free for more than 2 months during this period. What is the most
appropriate diagnosis?
A) Major depressive disorder, recurrent
B) Persistent depressive disorder (dysthymia)
C) Bipolar II disorder
D) Adjustment disorder with depressed mood
Correct Answer: B) Persistent depressive disorder (dysthymia)
Rationale: Persistent depressive disorder requires depressed mood for at least 2 years in
adults, with no symptom-free period exceeding 2 months. MDD is episodic. Bipolar II
requires hypomanic episodes. Adjustment disorder is tied to a specific stressor and is
typically less than 6 months.
QUESTION 4
A 55-year-old male presents with a 6-month history of excessive worry about his health,
finances, and family. He reports difficulty controlling the worry, muscle tension,
restlessness, and sleep disturbance. What is the most appropriate diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Obsessive-compulsive disorder
D) Illness anxiety disorder
,Correct Answer: A) Generalized anxiety disorder
Rationale: GAD requires excessive anxiety and worry about multiple domains for >6
months, difficulty controlling worry, and associated somatic symptoms (muscle tension,
restlessness, sleep disturbance). Panic disorder involves discrete panic attacks. OCD has
obsessions/compulsions. Illness anxiety disorder focuses specifically on health concerns.
QUESTION 5
A 22-year-old male reports auditory hallucinations, paranoid delusions, and
disorganized speech. Symptoms have been present for 5 months. He has had significant
social decline. No mood episodes have occurred. What is the most likely diagnosis?
A) Schizophrenia
B) Schizophreniform disorder
C) Brief psychotic disorder
D) Delusional disorder
Correct Answer: B) Schizophreniform disorder
Rationale: Schizophreniform disorder has the same symptoms as schizophrenia but with
duration of 1–6 months. If symptoms persist beyond 6 months, the diagnosis changes to
schizophrenia. Brief psychotic disorder is <1 month. Delusional disorder involves only
delusions.
QUESTION 6
A 42-year-old female presents with a 1-week history of elevated mood, decreased need
for sleep, grandiosity, and excessive involvement in pleasurable activities with high
potential for painful consequences. She has no psychotic features. What is the most
appropriate diagnosis?
A) Hypomanic episode
B) Manic episode
C) Cyclothymic disorder
D) Major depressive disorder with mixed features
Correct Answer: B) Manic episode
, Rationale: A manic episode requires at least 1 week of elevated/irritable mood with ≥3
symptoms (decreased need for sleep, grandiosity, excessive activities) causing marked
functional impairment. Hypomania is less severe and lasts ≥4 days without marked
impairment. Cyclothymia is chronic subthreshold symptoms. Mixed features include
depression symptoms.
QUESTION 7
A 65-year-old male with no psychiatric history develops acute confusion, disorganized
thinking, and visual hallucinations over 2 days following hip surgery. Symptoms
fluctuate throughout the day. What is the most likely diagnosis?
A) Alzheimer's disease
B) Delirium
C) Schizophrenia
D) Vascular dementia
Correct Answer: B) Delirium
Rationale: Delirium is characterized by acute onset, fluctuating course, and altered
consciousness/attention, often triggered by surgery, infection, or medication changes.
Alzheimer's disease has gradual onset. Schizophrenia has a different presentation.
Vascular dementia has stepwise decline.
QUESTION 8
A 38-year-old female reports a 4-year history of unstable relationships, impulsivity,
recurrent self-harm, and chronic feelings of emptiness. She has frantic efforts to avoid
abandonment. What is the most appropriate diagnosis?
A) Bipolar II disorder
B) Borderline personality disorder
C) Histrionic personality disorder
D) Narcissistic personality disorder
Correct Answer: B) Borderline personality disorder
Rationales | 2027 Edition
Prepare for the NR 547 PMHNP Midterm with this comprehensive study guide featuring original practice
questions, accurate answers, and detailed rationales. Covers psychiatric assessment, differential
diagnosis, DSM-5-TR disorders, psychopharmacology, neurobiology, evidence-based treatment, and
clinical decision-making essential for psychiatric-mental health nurse practitioner students. Perfect for
focused review, self-assessment, and building confidence before your NR 547 midterm exam.
QUESTION 1
A 45-year-old female presents with a 3-week history of depressed mood, anhedonia,
insomnia, and poor appetite. She reports that her symptoms began shortly after she was
diagnosed with breast cancer. She is able to perform her daily activities but with
significant effort. What is the most appropriate diagnosis?
A) Major depressive disorder
B) Adjustment disorder with depressed mood
C) Persistent depressive disorder
D) Uncomplicated bereavement
Correct Answer: B) Adjustment disorder with depressed mood
Rationale: Adjustment disorder is characterized by emotional or behavioral symptoms
within 3 months of an identifiable stressor (cancer diagnosis). The symptoms do not meet
full criteria for MDD. Persistent depressive disorder requires ≥2 years of symptoms.
Uncomplicated bereavement is related to loss of a loved one.
QUESTION 2
A 32-year-old male reports recurrent episodes of intense fear, palpitations, sweating,
and a feeling of choking that peak within 10 minutes. He has persistent worry about
having additional attacks and has changed his behavior to avoid situations that might
trigger them. What is the most likely diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Social anxiety disorder
D) Specific phobia
,Correct Answer: B) Panic disorder
Rationale: Panic disorder is characterized by recurrent unexpected panic attacks followed
by at least 1 month of persistent concern about additional attacks or significant
maladaptive behavioral changes. GAD involves pervasive worry without discrete panic
attacks. Social anxiety is limited to social situations. Specific phobia is triggered by a
specific object or situation.
QUESTION 3
A 28-year-old female presents with a 2-year history of persistent depressed mood, low
energy, poor appetite, low self-esteem, and hopelessness. She reports that she has
never been symptom-free for more than 2 months during this period. What is the most
appropriate diagnosis?
A) Major depressive disorder, recurrent
B) Persistent depressive disorder (dysthymia)
C) Bipolar II disorder
D) Adjustment disorder with depressed mood
Correct Answer: B) Persistent depressive disorder (dysthymia)
Rationale: Persistent depressive disorder requires depressed mood for at least 2 years in
adults, with no symptom-free period exceeding 2 months. MDD is episodic. Bipolar II
requires hypomanic episodes. Adjustment disorder is tied to a specific stressor and is
typically less than 6 months.
QUESTION 4
A 55-year-old male presents with a 6-month history of excessive worry about his health,
finances, and family. He reports difficulty controlling the worry, muscle tension,
restlessness, and sleep disturbance. What is the most appropriate diagnosis?
A) Generalized anxiety disorder
B) Panic disorder
C) Obsessive-compulsive disorder
D) Illness anxiety disorder
,Correct Answer: A) Generalized anxiety disorder
Rationale: GAD requires excessive anxiety and worry about multiple domains for >6
months, difficulty controlling worry, and associated somatic symptoms (muscle tension,
restlessness, sleep disturbance). Panic disorder involves discrete panic attacks. OCD has
obsessions/compulsions. Illness anxiety disorder focuses specifically on health concerns.
QUESTION 5
A 22-year-old male reports auditory hallucinations, paranoid delusions, and
disorganized speech. Symptoms have been present for 5 months. He has had significant
social decline. No mood episodes have occurred. What is the most likely diagnosis?
A) Schizophrenia
B) Schizophreniform disorder
C) Brief psychotic disorder
D) Delusional disorder
Correct Answer: B) Schizophreniform disorder
Rationale: Schizophreniform disorder has the same symptoms as schizophrenia but with
duration of 1–6 months. If symptoms persist beyond 6 months, the diagnosis changes to
schizophrenia. Brief psychotic disorder is <1 month. Delusional disorder involves only
delusions.
QUESTION 6
A 42-year-old female presents with a 1-week history of elevated mood, decreased need
for sleep, grandiosity, and excessive involvement in pleasurable activities with high
potential for painful consequences. She has no psychotic features. What is the most
appropriate diagnosis?
A) Hypomanic episode
B) Manic episode
C) Cyclothymic disorder
D) Major depressive disorder with mixed features
Correct Answer: B) Manic episode
, Rationale: A manic episode requires at least 1 week of elevated/irritable mood with ≥3
symptoms (decreased need for sleep, grandiosity, excessive activities) causing marked
functional impairment. Hypomania is less severe and lasts ≥4 days without marked
impairment. Cyclothymia is chronic subthreshold symptoms. Mixed features include
depression symptoms.
QUESTION 7
A 65-year-old male with no psychiatric history develops acute confusion, disorganized
thinking, and visual hallucinations over 2 days following hip surgery. Symptoms
fluctuate throughout the day. What is the most likely diagnosis?
A) Alzheimer's disease
B) Delirium
C) Schizophrenia
D) Vascular dementia
Correct Answer: B) Delirium
Rationale: Delirium is characterized by acute onset, fluctuating course, and altered
consciousness/attention, often triggered by surgery, infection, or medication changes.
Alzheimer's disease has gradual onset. Schizophrenia has a different presentation.
Vascular dementia has stepwise decline.
QUESTION 8
A 38-year-old female reports a 4-year history of unstable relationships, impulsivity,
recurrent self-harm, and chronic feelings of emptiness. She has frantic efforts to avoid
abandonment. What is the most appropriate diagnosis?
A) Bipolar II disorder
B) Borderline personality disorder
C) Histrionic personality disorder
D) Narcissistic personality disorder
Correct Answer: B) Borderline personality disorder
